Medications for Heart Failure

Medications for heart failure are used to relieve and control the symptoms of heart failure, improve daily functioning and quality of life, and reduce the need to be hospitalized. Most importantly, however, the correct medication, at the correct doses can slow and even reverse the progression of the disease and reduce the rate of premature death.

• Medication for heart failure specifically focuses on: 
• Preventing fluid retention or removing excess fluid 
• Reducing the work of the heart 
• Helping the heart pump stronger 
• Reducing the effect of the body's attempt to compensate for heart failure 
• Treat the risk factors for coronary artery disease and heart failure, especially high blood pressure and diabetes

Medication Categories
The American College of Cardiology, the American Heart Association, and the Heart Failure Society of America have established guidelines for medications to be used for people with heart failure.

There are 3 main classes that are used to treat heart failure and slow or reverse the process that causes the heart to become progressively worse. The act directly on the excessive hormones levels and nervous system activation that occurs when the body tries to compensate for heart failure. 

1. Angiotensin Converting Enzyme Inhibitor (ACE-I) 

• Vasotec (enalapril) 
• Capoten (captopril) 
• Prinivil, Zestril (lisinopril) 
• Accupril (quinipril) 
• Altace (ramipril) 
• Mavik (tandolapril) 
• Monopril (fosinopril) 
• Lotensin (benazepril) 
• Univasc (moexipril) 

2. Beta-blockers 

• Coreg (carvedilol) 
• Lopressor (metoprolol tartrate) 
• Toprol XL (metoprolol succinate) 

3. Aldosterone Receptor Antagonists

• Aldactone (spironolactone) 
• Inspra (eplerenone)

You should be taking a medication from each of these 3 classes of medications unless there is a specific reason not to. If you are not these medications, you should discuss your medications with your physician.

Other medications are frequently used to treat the fluid retention, assist your heart to pump stronger, and treat your cardiovascular risk factors. These include: 

1. Diuretics - used to treat fluid retention. Potassium supplements may be required 
2. Digoxin - used to assist the heart to pump stronger and treat some irregular heart rhythms. Has been shown to reduce hospitalizations 
3. Angiotensin Receptor Blockers (ARB) - can substituted for the ACE-I if the person experiences cough while taking the ACE-I. 
4. Medications to treat high blood pressure 
5. Medications to treat high cholesterol 
6. Medications to treat diabetes 
7. Aspirin to prevent clot formation in people with coronary artery disease 
8. Coumadin (blood thinner) for people with irregular heart rhythms, especially atrial fibrillation 
9. Medications to treat abnormal heart rhythms 
10.Medications to treat angina

Clinical trials using heart failure medicine for people with heart failure has determined the dose that is most effective in reducing symptoms and complications of heart failure and the progressive worsening of the heart. The most effective dose for all of the heart failure medications is called the target dose. Medications for heart failure are usually started at low doses to avoid complications. The dose is then increased every 2-4 weeks until the target dose is reached. Even if your symptoms have resolved, it is very important to continue to increase the dose until the target dose is reached. You will want to discuss the target dose for each of your medications with your doctor.

Taking medications properly can reduce your chance of being hospitalized. Because you will be taking several medications, it is easy to get them confused. Common mistakes can include taking the medication at the wrong time, taking the wrong dose, forgetting to take the medicine, and taking the medicine twice. The following are some helpful tips in taking medication correctly: 

• Take only what your doctor tells you to take 
• Don't stop taking your medication unless your doctor tells you to 
• Call your doctor is you start experiencing any new symptoms after you start a new medication, or the dose is changed 
• Use a Medicine Log to keep track of the medicine you are taking. Take it with you to your doctor appointments and write down any changes your doctor makes 
• Use a 7-day pill box or pill organizer. Then you won't get your medicine mixed up and can tell if you took them (they are not expensive and can be found in all drug stores) 
• Keep a list of your medicines with you in a wallet or purse 
• Try to take your medicine at the same time each day 
• If you forget to take your medicine, don't take more the next time 
• Get your prescriptions refilled before you run out 
• Don't run out of your medicine 
• Talk to your doctor before you take over-the-counter medicine from the drug store